The impact of the Fundamental Critical Course on knowledge acquisition in Rwanda.

Background: Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained in critical care, and mortality rates are unacceptably high in this patient population. Objectives: We sought to retrospectively describe the knowledge acquisition and confidence improvement of practitioners who attend the Fundamental Critical Care Support (FCCS) course in Rwanda. Methods: We conducted a retrospective study in which we assessed survey data and multiple-choice question data that were collected before and after course delivery. The purpose of these assessments at the time of delivery was to evaluate participants' perception and acquisition of critical care knowledge. Results: Thirty-six interprofessional clinicians completed the training. Performance on the multiple-choice questions improved overall after the course (mean score pre-course of 56.5% to mean score post-course of 65.8%, p-value <0.001) and improved in all content areas with the exception of diagnosis and management of acute coronary syndrome and acute respiratory failure/mechanical ventilation. Both physicians and nurses improved their scores significantly (68.9% to 75.6%, p-value = 0.031 and 52.0% to 63.5%, p-value <0.001, respectively). Self-reported confidence in level of knowledge also increased in all areas. Survey respondents indicated on open-answer questions that they would like the course offerings at least annually, and that further dissemination of the course in Rwanda was warranted. Conclusion: Deploying the established FCCS course improved Rwandan healthcare provider knowledge and confidence across most critical care content areas. Therefore, this course represents a good first step in bridging the gaps noted in emerging critical care systems. Contributions of the study: Critical care education in sub-Saharan Africa is limited and few staff have formal training. The aim of the study was to determine whether a focused course delivered in Rwanda on critical care management improved knowledge in key areas. Our retrospective study on results from a multiple choice question test and survey indicate that short courses may improve knowledge of critical care management.

Primary Care Provider Understanding of Hair Care Maintenance as a Barrier to Physical Activity in African American Women.

INTRODUCTION: African American (AA) women have reported hair maintenance as a barrier to regular exercise; however, to our knowledge, this study is the first to identify primary care provider thoughts, attitudes, beliefs, and knowledge regarding hair as a barrier to increased physical activity among AA females. METHODS: A 13-question electronic survey was sent via email to 151 clinicians working within a department of family medicine's 8 ambulatory clinics within a large urban academic medical center. RESULTS: A total of 62 primary care clinicians completed the survey, which is a response rate of 41%. The vast majority of respondents (95%) sometimes/often engage in discussions with AA female patients regarding physical activity. However, 76% of respondents have never included a hairstyling or maintenance assessment in that discussion and only 34% noted being comfortable discussing this topic. Among a list of potential barriers to exercise, hair maintenance/scalp perspiration was rarely endorsed as important by clinicians. DISCUSSION: This study highlights a need for increased education among primary care providers regarding AA hair care and maintenance practices as a barrier to increased physical activity in AA women. If specific barriers to increasing healthy habits among AA women are to be addressed, there must be a baseline knowledge of hair care and maintenance barriers, an understanding of the strong influence of cultural norms and practices as it relates to physical activity and exercise, and an increased comfortability when engaging in difficult cross-cultural conversations to ultimately improve health outcomes in AA females.

Refinement and use of Certificates of Veterinary Inspection (Health Certificates) for optimal assurance of disease freedom in aquatic animals.

Certificates of Veterinary Inspection (CVI), generally termed "Health Certificates", are pivotal for ensuring that translocated animals are not diseased or do not harbour significant pathogens. While used very successfully with terrestrial animal movement for decades, CVIs for aquatic animals are not well refined, understood or used, despite the availability of several aquatic animal "certification processes", "permits" and "health certificates", including the OIE model health certificates. Correctly designed CVIs provide the single most economical and effective assurance of disease status (generally freedom from specific diseases or pathogens) for individuals or lots of animals, at any point in time. When issued by a qualified independent third-party (typically a licensed and government accredited veterinarian) they provide the official level of assurance necessary for intrastate, interstate and international trade. Tailored modifications of CVIs are also useful for other purposes requiring the evaluation of animal health (e.g. specific pathogen-free (SPF) assurance for premises, risk-mitigating assurance necessary for insurance policies, breeding soundness assurance of broodstock, etc.). Here we discuss necessary information for aquatic animal CVIs: animal, ownership and location; standardized diagnostic results and their interpretation; and language contained in CVIs. Also addressed is the viability for use with multiple aquatic species and diseases/pathogens of interest, and their use in conjunction with established veterinary inspection procedures. A revised model aquatic CVI, with broad potential use for individual operations, states or countries, is offered for discussion, comment and refinement. In addition an optimally designed model CVI may be of use with electronic systems that are evolving in, for example, Europe, the USA and Australia/New Zealand (e.g. TRACES, e-CVI, e-Certs).

A synchrotron X-ray scattering characterization of purified tubulin and of its expansion induced by mild detergent binding.

This report presents a synchrotron radiation X-ray scattering characterization of calf brain tubulin purified by the modified Weisenberg procedure. The results show that under nonassembly conditions (i.e., in 10 mM sodium phosphate and 0.1 mM GTP, pH 7, buffer) these preparations consist of a uniform population of molecules with a radius of gyration of 3.1 +/- 0.1 nm, which can be interpreted as arising from the native alpha-beta heterodimer. The uniformity in the population persists even at unusually high concentrations of protein. Binding of colchicine or substitution of GTP by GDP does not induce, within the statistical accuracy and resolution range of our measurements, any significant structural modification in soluble tubulin. In assembly buffer [i.e., 10 mM sodium phosphate, 6 mM magnesium chloride, 1 mM [ethylenebis(oxyethylenenitrilo)]tetraacetic acid, 1 mM GTP, and 3.4 M glycerol, pH 6.5], these preparations readily assemble into microtubules upon increasing the temperature from 4 to 37 degrees C. Binding of nondenaturing amphiphiles to soluble tubulin provides a simplified model for tubulin-membrane interactions. The X-ray scattering data show that the radius of gyration of tubulin progressively increases upon binding of the mild detergent sodium deoxycholate, reaching a maximum value of 4.3 +/- 0.1 nm at detergent saturation. The relative increase in the radius of gyration coincides within experimental error with the previously determined relative increase in the frictional coefficient [Andreu, J.M., & Muñoz, J.A. (1986) Biochemistry 25, 5220-5230]. Analysis of these observations suggests that the effect of detergent binding is to induce an isotropic swelling of the protein structure.

The role of microtubules in pinocytosis. Inhibition of fluid-phase pinocytosis in the rat visceral yolk sac by mitoclasic and related agents.

Colchicine, demecolcine and vinblastine all effectively inhibited the pinocytic capture of 125I-labelled poly(vinylpyrrolidone) by rat visceral yolk sacs cultured in vitro. Complete inhibition did not occur until 2-3h after addition of mitoclasic agent and this delay appeared to be related to the mechanism of drug-microtubule interaction rather than any difficulty of drug permeation into cells. Inhibition of pinocytosis by demecolcine was reversible, whereas inhibition by colchicine or vinblastine was not. In terms of dose-response demecolcine was slightly more effective than colchicine, but both were considerably more active than trimethylcolchicinic acid. Of the nine benzimidazoles tested for ability to inhibit pinocytosis, four severely retarded uptake and three were partially inhibitory.

Pinocytosis of poly (alpha, beta-(N-2-hydroxyethyl))-DL-aspartamide and a tyramine derivative by rat visceral yolk sacs cultured in vitro. Ability of phenolic residues to enhance the rate of pinocytic capture of a macromolecule.

Incorporation of 20% tyramine residues into its structure greatly increased the rate of pinocytosis of poly(alpha, beta-(N-2-hydroxyethyl))-DL-aspartamide (PHEA) by rat visceral yolk sacs cultured in vitro. Both the parent macromolecule and the tyramine derivative (PHEA-tyramine) were captured by adsorptive pinocytosis, the higher affinity of the derivative for the yolk sac plasma membrane being responsible for its greater rate of capture. Using 125I-labelled PHEA-tyramine, the relationship between substrate concentration and rate of capture was determined, it was also shown that following internalization, the PHEA-tyramine linkage is resistant to intracellular hydrolysis. Fluorescence micrographs were consistent with capture of both substrates being by pinocytosis and illustrated the highly efficient concentration of the tyramine derivative by yolk sac endodermal cells.

Two ultrastructurally distinct tubulin paracrystals induced in sea-urchin eggs by vinblastine sulphate.

Two types of ultrastructurally distinct tubulin paracrystals have been induced in sea-urchin eggs with vinblastine sulphate (VLB) under different sets of conditions. One type of paracrystal appears to consist of hexagonally-close packed microtubules and closely resembles paracrystals present in mammalian cells treated with vinblastine or vincristine sulphate, but not previously reported in sea-urchin eggs. The other type is also made up of tubulin subunits, but these do not seem to have polymerized into microtubules. Both types of paracrystal are induced in sea-urchin eggs in the presence of VLB at a time when tubulin subunits would not normally polymerize. Possible mechanisms for tubulin activation and the induction of paracrystal formation are discussed in respect to the available information on the binding sites of the tubulin subunits.

The effects of mitotic inhibitors on the structure of vinblastine-induced tubulin paracrystals from sea-urchin eggs.

Vinblastine sulphate (VLB) is known to induce in vivo formation of tubulin paracrystals in sea-urchin eggs. Corresponding paracrystals have been prepared in the presence of both vinblastine sulphate and other mitoclasic agents. Careful standardization of conditions was required to restrict the formation of alternative forms of the paracrystals induced by vinblastine alone. Comparisons were made between preparations in terms of paracrystal shape, size, proportion of eggs containing paracrystals, number per egg and their relative times of first appearance. A correlation between such properties were established. Comparison of paracrystals at the ultrastructural level showed them all to be similar regardless of the drugs present during their formation. The implications of tubulin polymerization in the presence of mitoclasic agents are discussed and mechanisms for paracrystal enhancement by combinations of such drugs are suggested. Some similarities of paracrystal and microtubule seeding are discussed together with the activation of tubulin in the pool.